Milkman's Syndrome

MILKMAN'S syndrome is a form of osteomalacia characterized radiologically by radiolucent zones or bands of decalcification traversing otherwise normal-appearing bone, usually at right angles to the long axis of the bone. These ribbon-like bands have been called “pseudofractures,” “Looser's lines,” “Umbauzonen,” “Umbaufrakturen,” “multiple spontaneous idiopathic symmetrical fractures,” “osteoporosis melolytica,” “insufficiency fractures,” and “spontaneous fractures.”

History

Mention of this phenomenon dates back to 1881, when Parker1 reported the postmortem presence of spontaneous bilateral fractures in several ribs of a 12-month-old child with rachitic deformities. Feiss,2 in 1905, described the condition of a four-year-old rachitic child with bilateral multiple spontaneous fracture-like zones, but with no displacement of fragments or other evidence of true fractures. In 1911, Hagemann and Eringhaus were reported by Fromme3 to have found peculiar spontaneous fractures in a patient in the late stage of rickets.

In 1920, Looser4 described radiolucent zones observed in his study of cases of starvation in Central Europe after World War I. He originally described the lesions as “transverse or oblique fissures or band-like . . . radiolucencies which divide the bone into two pieces but are not roentgenologically or clinically actual fractures.” In 1930 and in 1934, Milkman5, 6 described this syndrome as a separate disease entity. He related his work to that of Looser, but since Milkman's first reports, this condition has become associated with his name and, to date, reports of more than 60 cases of Milkman's syndrome have been published.